A battle over breasts

By Howard Kurtz
Washington Post Staff Writer
Friday, November 20, 2009 9:55 AM

I have never seen a government health-care finding get shouted down as loudly or vociferously as this strange recommendation on mammograms.

Almost in unison, journalists, politicians and ultimately White House officials reacted to the advice that women in their 40s no longer seek breast cancer screening with this question: What were they thinking? (And I'm cleaning it up.)

I understand that there's a serious scientific debate over the positive and negative aspects of mammography, and the don't-worry-be-happy-till-you're-50 finding of the U.S. Preventive Services Task Force grows out of such research. But that brings us to the essential problem with such studies.

In the broad sphere of health care, it may well be that some tests produce minimal returns -- and, worse, might lead to unnecessary surgery, as the task force noted.

But what if the patient involved is your mother, your sister, your daughter? Wouldn't you want her to have the cancer screening? Wouldn't you rather she have the information? What if a mammogram could have saved her life?

The questions answer themselves. Experts can spout off -- and influence insurance company practices -- but in the end it's a very personal decision. The situation is not unlike the debate surrounding prostate cancer and whether regular testing is desirable or potentially harmful. And Friday's recommendation by a medical group that young women wait until 21 to get their first Pap smear has just added to the confusion.

For women, of course, this is not some abstract debate. I've been struck by the highly personal tone some commentators are taking. But it's hardly surprising. If you've had breast cancer, or are worried about getting breast cancer, it's not like writing about Medicare reimbursement rates. You're talking about a clear and present danger.

Little wonder, then, that Kathleen Sebelius wasted no time making the media rounds. The Obama team already had to grapple with the phony "death panels" charge over the summer. No way it wants to be blamed for the actual deaths of women who pass up lifesaving tests.

NYT: "The Obama administration distanced itself Wednesday from new standards on breast cancer screening that were recommended this week by a federally appointed task force, saying government insurance programs would continue to cover routine mammograms for women starting at age 40. . . . Administration officials also fired back against Republicans who argued that the recommendations illustrated the dangers of an expanded government role in medical decision making."

WP: "A top federal health official said Wednesday that the controversial new guidelines for breast cancer screening do not represent government policy, as the Obama administration sought to keep the debate over mammograms from undermining the prospects for health-care reform. . . . While hailed by many patient advocates and breast cancer experts, the new guidelines have been harshly criticized by the American Cancer Society, the American College of Radiology and others, including some members of Congress."

But it is the personal voices that are truly absorbing. Time's Karen Tumulty pronounced herself "flummoxed by this report. I think it proves that even scientists can be pinheads. My issue is not with their recommendations on when and how often women should get mammograms. That seems worthy of debate. What I don't get is their finding that women should not even do self-examinations. And why? Because if we find a lump, it might make us worried. . . .

"That got me thinking a bit about my own history, which on one level might seem to vindicate these findings. I'm a cancer survivor; it has been almost 22 years since I was diagnosed with thyroid cancer, which required surgical removal of my thyroid, followed by two years of radioactive iodine. I was lucky, especially given the fact that the lump in my thyroid had been there for eight years, misdiagnosed as benign.

"But breast cancer was my first big scare -- at age 19, when I discovered lumps in both my breasts that didn't go away after a couple of menstrual cycles. That's when I had my first mammogram. . . .

"So it would seem I'm the perfect example of a person who shouldn't have had mammograms, or even examined my own breasts. But am I sorry I've had the information I've had through mammograms and self-exams? Not for a second.

"That's why I think these scientists are pinheads. Pink ribbons are lovely, but women who want information should have it."

Impossible, in my view, to argue with that.

"Given my stress level and control-freak, Type-A nature," says the New Republic's Michelle Cottle, "I'm likely to drop dead of a heart attack years before my mammaries malfunction.

"Still, there's something about the idea of one's breasts -- body parts tiresomely fetishized from the moment they spring forth -- turning lethal that makes some women crazy. Count me among them.

"It doesn't help that I have some of the screwiest breasts this side of the Mississippi. Oh, they look perfectly normal, and, when it came time to nurse my children, they worked just fine. But, clinically speaking, the tissue is a disaster, so dense and knotty it renders mammograms largely useless and self examines an impossibility. . . .

"A little over a year ago, my ob finally sent me to a breast surgeon, who wound up recommending I get screened every six months -- alternating between a mammogram-sonogram combo and the more involved MRI. Better safe than sorry, right?

"Not necessarily. After chewing it over for a few months, I decided to object. Even setting aside the radiation (it's minimal these days) and the creepy chemicals they pump into you before stuffing you inside the coffin, er, MRI tube, it's the grinding anxiety leading up to the tests that really gets me. Factor in the conflicting data about the value this level of screening provides in reducing the odds I'll be eaten alive by my own breasts, and I reached the conclusion that, barring scary new developments, I prefer not do this dance twice a year for the rest of my life -- which is the discussion I must have with my breast surgeon at next week's appointment."

A perfectly reasonable decision -- and one that should be left to her.

Another critic of the government recommendation, who's been down that road, is NYT columnist Gail Collins :

"My general impression is that the U.S. Preventive Services Task Force feels that younger women should not let anybody near their breasts unless the plan is to have sex.

"The report triggered two immediate and inevitable responses. Doctors and patients began an animated discussion. And Republicans declared it was all a Democratic plot. . . .

"I had breast cancer back in 2000, and I am trying to come up with a way that I can use that experience to shed some light on these new findings. I have never believed that everything happens for a reason. But I do feel very strongly that everything happens so that it can be turned into a column. . . .

"I had mammograms every year like clockwork, and I had just gotten a clean bill of health from my latest one when I found a lump on my left breast while watching a rerun of 'Buffy the Vampire Slayer,' multitasker that I am. . . .

"The only thing that bothers me about the mammogram report is all the emphasis on the 'anxiety' that might follow a false-positive. We live in a time when we are constantly being reminded that a fellow plane passenger might be trying to smuggle explosives in his sneakers. We can manage anxiety."

Post-China letdown

Even the MSM is saying Obama didn't get squat on his overseas trip, and Fred Barnes is happy to add his voice:

"Has a president ever been less successful on a trip overseas than President Obama has on his eight-day excursion to Asia? I've been covering presidents since Gerald Ford and I can't think of one.

"Obama struck out on his entire agenda in China and he acquiesced as the Chinese subjected him to the humiliation of a choreographed town hall meeting with student members of the Young Communist League. And he suffered through a 30-minute news conference with Chinese President Hu Jintao in which no questions from the media were allowed. Presidents normally come away on visits to foreign countries with 'deliverables' -- that is, tangible signs of progress like a treaty signing. All Obama got was a list of things the United States and China would do in the future. There's a name for this: diplomatic boilerplate.

"Obama's aides and flacks insisted he wasn't looking for immediate gains in the American relationship with China. Instead he was developing stronger relations for long term. This reminds me of what his defenders say about a football running back who doesn't gain many yards. He's a great blocker. Yeah, right!"

Friday follies

Karl Rove continues to argue that 44 is worse than 43 in every conceivable way:

"Every modern White House has put out news on contentious issues late on Friday in the hope that doing so will bury it, or reduce the amount of critical scrutiny it would otherwise receive. What is unusual is the degree to which this White House has relied on this tactic."

Having acknowledged that the Bush crowd did the same thing, Rove cites a bunch of allegedly bad-news announcements by Obama, culminating in "this past Friday, when the White House delivered a double news dose with a foreign twist. Attorney General Eric Holder announced that Khalid Sheikh Mohammed and five other terrorists would be tried in a civilian court in New York City rather than before a military tribunal. Later that day, the administration announced that White House Counsel Greg Craig was leaving and would be replaced by Democratic National Committee lawyer Bob Bauer. Mr. Obama? He was safely in the air flying to Asia, having left the day before with most of his press corps in tow."

Excuse me, but the KSM news was hardly buried, and it got an avalanche of coverage. As for Greg Craig leaving, are there 20 people in America who care?

"Do Friday news dumps work? Yes, but marginally. The White House press corps is generally exhausted at the end of a long week. Congressional critics are either in route back home to their districts or already there. Friday night network television news and Saturday newspapers and cable coverage are traditionally less seen or read. By Sunday morning, a Friday announcement is often considered old news. Monday is the first opportunity White House correspondents get to ask the president's press secretary on camera about whatever was released Friday. By then there is almost always other news occupying the headlines.

"Such tactics, however, can look disingenuous if they undercut public debate on substantive policy changes -- such as deciding to bring terrorists to New York for trial."

Washington Monthly's Steve Benen complains about "the almost farcical column is in keeping with Rove's general m.o. Rove ran a White House that embraced a 'permanent campaign,' so he's accused the Obama team of embracing a 'permanent campaign.' Rove embraced the politics of fear, so he's accused Obama of embracing the politics of fear. Rove relied on 'pre-packaged, organized, controlled, scripted ' political events, so he's accused Obama of relying on 'pre-packaged, organized, controlled, scripted' political events. Rove looked at every policy issue 'from a political perspective,' so he's accused Obama of looking at every policy issue 'from a political perspective.' Rove snubbed news outlets that he considered partisan, so he's accused Obama of snubbing . . . news outlets that he considered partisan."

Which happens to be true, in the case of Fox News -- at least until the sit-down in Beijing earlier this week.

Plagiarism politics

I've never seen anything like this legal spat in Connecticut:

"The Journal Inquirer on Wednesday brought suit against the Hartford Courant, seeking financial damages for news stories the Courant acknowledged plagiarizing from its suburban competitor this summer.

"The JI's suit, filed in Hartford Superior Court by West Hartford lawyer Richard P. Weinstein, alleges violation by the Courant of federal copyright law and Connecticut's Unfair Trade Practices Act. The suit documents 11 incidents of plagiarism by the Courant in July, August, and September and says there may have been more."

The Courant has admitted the plagiarism, blaming -- get this -- "a mistake in our editing process." No fooling.

Box office Sarah

The Hollywood Reporter reports that "Oprah Winfrey's interview with former vp candidate Sarah Palin scored the talk show host her highest rating in two years. Monday's episode of 'The Oprah Winfrey Show' drew a 8.7 household rating and 13 share -- the best since Winfrey had the entire Osmond family on the show in 2007."

Higher than the Osmonds? Wow.

Rudy punts

"Former Mayor Rudolph W. Giuliani has decided not to run for governor of New York next year after months of mulling a candidacy, according to people who have been told of the decision."

I knew he didn't want to live in Albany.

Rupert retreats

Not the smartest crack Murdoch ever made, as the Daily News reports:

"A contrite Rupert Murdoch placed a personal call to Gov. David Paterson to apologize for slamming the legally blind governor during a Wall Street Journal CEO Council earlier this week, a source close to Paterson confirmed. The News Corp. CEO called Paterson in Albany around noon.

"Paterson not only accepted the call, but also accepted Murdoch's apology for saying political discourse in New York has become so polarized because the governor is 'blind, and can't read Braille, and doesn't know what's going on.' "


Best NYT correction in a long time: "An Op-Ed article on Wednesday, about the founders' debates about climate, misstated the status of the United States in the winter of 1783. It was an independent country, not a collection of colonies."

Howard Kurtz also works for CNN and hosts its weekly media program, "Reliable Sources."

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